The Investigation Effects of Pregabalin and Duloxetine Treatment According to Personality Characteristics Groupe with Fibromyalgia Patients

Abstract

This study was to compare the effects of duloxetine and pregabalin on fibromyalgia(FMS)patients with different personalities. A total of 102 female with FMS who applied to outpatient clinics of the Department of PhysicalMedicine and Rehabilitation in Duzce University Medical School between October (2013)December (2014),were grouped according to their personality characteristics. Each personalitygroup was also randomly divided in two groups. One group received 60 mg/day duloxetine andthe other group received 300 mg/day pregabalin for 12 weeks.The pain intensity of the patientswas evaluated with VAS,their sleep quality was evaluated with VAS–sleep score,depression wasevaluated with Beck Depression Scale(BDS), quality of life was evaluated with SF-36, andfunctioning was evaluated with Fibromyalgia Impact Questionnaire(FIQ) before and aftertreatment. Thirty of the neurotic group received duloxetine, 31 received pregabalin while 20 of theextroverts received duloxetine and 21 received pregabalin.Significant improvements wereobtained in the neurotic-duloxetine and extroverted-pregabalin groups in terms of BDS andgeneral health perceptions dimension of SF-36. Significant improvements were observed in allgroups in terms of VAS,VAS-Sleep and sensitive points.The increase after treatment in physicalfunctioning,physical role functioning, vitality,mental health and bodily pain in SF-36 wassignificant in all groups.The increase in emotional role functioning was significantly higher inonly neurotic-duloxetine and neurotic–pregabalin groups.Whereas the effects of treatments werenot found statistically significant on vitality in all groups.The decrease in FIQ scores wassignificant in extroverted–duloxetine and extroverted–pregabalin groups. Treatment should be initiated with pregabalin in extroverts, and duloxetine in neurotics

Keywords

• Fibromyalgia,personality characteristics,pregabalin,duloxetine

FİBROMİYALJİLİ HASTALARDA KİŞİLİK ÖZELLİKLERİNE GÖRE PREGABALİN VE DULOKSETİN TEDAVİLERİNİN ETKİNLİĞİNİN KARŞILAŞTIRILMASI

Abstract

Çalışmamızda fibromiyalji sendromlu (FMS) hastaları kişilik özelliklerine göre ayırıp,kişiliklerde duloksetin, pregabalin tedavisinin etkinliklerini araştırmak, etkinlikleri birbirleriylekarşılaştırmak amaçlandı. FMS’li 102 kadın hasta Eysenck Kişilik Anketi kullanılarak kişiliközelliklerine göre gruplandırıldı. Her kişilik grubu kendi arasında rastgele iki gruba ayrıldı. 12hafta süreyle gruplardan birine 60 mg/gün duloksetin, diğerine 300 mg/gün pregabalin tedavisiuygulandı. Hastaların tedavi öncesi ve sonrası ağrı şiddetleri Visual Analog Skala, uyku kaliteleriVAS-uyku skoru, depresyonları Beck Depresyon Ölçeği (BDÖ), yaşam kalitesi SF-36,fonksiyonel durumları Fibromiyalji Etki Anketi (FIQ) ile değerlendirildi. Tedaviye alınan hastaların 61’i (%59,8) nörotik, 41’i (% 40,2) dışa dönük kişilik özelliğindeydi.Nörotik grubun 30’u duloksetin, 31’i pregabalin; dışa dönüklerin 20’si duloksetin, 21’ipregabalin tedavisine alındı. Her iki ilaç SF-36’nın enerji, fiziksel rol güçlüğü, genel sağlık,ağrı, mental sağlık boyutlarında kişilik özelliklerinden bağımsız düzelme sağladı. Fizikselfonksiyonda duloksetin alan nörotik ve pregabalin alan dışa dönük grupta düzelme oldu.Emosyonel rol güçlüğünde nörotiklerde ilaçlardan bağımsız düzelme saptandı. Sosyalfonksiyonlarda hiçbir grupta iyileşme olmadı. FIQ skorunda düzelme ilaçlardan bağımsız dışadönük grupta daha fazla görüldü. BDÖ’ de düzelme duloksetin alan nörotikler ve pregabalinalan dışa dönüklerde oldu. Hassas noktalar ve VAS’da bütün gruplarda düzelme oldu. Ancakduloksetin alan nörotiklerde ve pregabalin alan dışa dönüklerde düzelme daha fazla oldu. VASuyku skorları tüm gruplarda düzelme gösterdi. FMS tedavisinde kişilik özellikleri önemlidir.Dışa dönükler tedaviye daha iyi cevap vermektedirler. Tedaviye öncelikle dışa dönüklerdepregabalin, nörotiklerde duloksetin başlanmalıdır

Keywords

• Fibromiyalji sendromu,kişilik özellikleri,pregabalin,duloksetin

References

1. Akiko Okufuci, Bradford D. Hare management of fibromyalgia syndrome: review of evidence. Pain Ther. 2013; 2(2) :87-104.
2. Lera S, Gelman SM, Lopez MJ, Abenoza M, Zorrilla SG, Castro-Fornieles J, et all. Multidisciplinary treatment of fibromyalgia: does cognitive behaviour therapy increase the response to treatment? J Psychosom res. 2009; 67(5) :433-41.
3. Di Tella M, Castelli L. Alexithymia and fibromyalgia: clinical evidence. Front Psychol. 2013; 4 :909.
4. Unubol İyiyapıcı A, Bozbaş Taşçı G, Unubol M, Gurer G. An evaluation of mean platelet volume and serum lipid profile in patients with fibromyalgia syndrome. Archives of Rheumatology. 2013; 28(4) :251-55.
5. Goldenberg L. Using multidisciplinary care to treat fibromyalgia. J Clin Psychiatry. 2009; 70(5) :e13.
6. Korkan Akın E, Uyar M. Evidence-based approach to pain control: reflexology. ACU Health Sci Journal. 2014 (1) :9-14.
7. Tutuncu R, Gunay H. Chronic pain, psychological factors and depression. Dicle Medical Journal. 2011; 38 (2): 257-62.
8. Guler N, Kaptanoglu E, Sahin O, Hizmetli S, Elden H. The effectiveness of gabapentine in female patients with fibromyalgia. Cumhuriyet Med J. 2010; 32 :40-7.

9. Romeyke K, Scheuer HC, Stummer H. Fibromyalgia with severe forms of progression in a multidisciplinary therapy setting with emphasis on hyperthermia therapy – a prospective controlled study. Clin Interv Aging. 2014; 10 :69-79.
10. Malemud CJ. Focus on pain mechanisms and pharmacotherapy in the treatment of fibromyalgia syndrome. Clin Exp Rheumatol. 2009; 27(56) :86-91.
11. Malin K, Littlejohn GO. Neuroticism in young women with fibromyalgia links to key clinical features. Pain research and treatment. 2012; doi:10.1155/2012/730741.
12. Martinez MP, Sanchez AI, Miro E, Medina A, Lami MJ. The relationship between the Fear-Avoidance model of pain and personality traits in fibromyalgia patients. J. Clin Psychol Med. 2011; 18 :380-91.
13. Clauw DJ. Fibromyalgia: an overview. Am J Med. 2009; 122(12) :3-13.
14. Wright A, Luedtke KE, Vandenberg C. Duloxetine in the treatment of chronic pain due to fibromyalgia and diabetic neuropathy. J Pain Res. 2010; 4 :1-10.
15. Arnold LM, Clauw D, Wang F, Ahl J, Gaynor PJ, Wollreich MM. Flexible dosed duloxetine in the treatment of fibromiyalgia: a randomized, double-blind, placebo- controlled trial. The Journal of Rheumatology 2010; 37(12) :2578-86.
16. Arnold LM, Lu Y, Crofford LJ, Wohlreich M, Detke MJ, Iyengar S, Goldstein DJ. A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheumatism 2004; 50(9) :2974-84.
17. Chappell AS, Bradley LA, Wiltse C, Detke MJ, D’Souza DN, Spaeth M. A six-month double-blind, placebo-controlled, randomized clinical trial of duloxetine fort he treatment of firomyalgia. Int J Gen Med. 2008; 1 :91-102.
18. Mease PJ, Russell IJ, Arnold LM, Florian H, Young JP, Martin SA, Sharma U. A randomized, double-blind, placebo- controlled, phase III trial of pregabalin in the treatment of patients with fibromyalgia. The Journal of Rheumatology 2008; 35(3) :502-14.
19. Ohta H, Oka H, Usui C, Ohkura M, Suzuki M, Nishioka K. A rando mized, double-blind, multicenter, placebo-controlled phase III trial to evaluate the efficacy and safety of pregabalin in Japanese patients with fibromyalgia. Arthritis Res Ther. 2012; 14(5) :217.
20. Arnold LM, Russell IJ, Diri EW, Duan WR, Young JP, Sharma U, Martin SA, Barrett JA, Haig G. A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia. The Journal of Pain 2008; 9(9) :792-805.
21. Clauw DJ. Fibromyalgia: an overview. Am J Med. 2009; 122(12) :3-13.